Online Forms

Drop Off Consent Form

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Online Forms

Drop Off Consent Form

Thank you for choosing Florence Animal Hospital. Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

Pet's Name *

Client's Name *

Email *

Did your pet eat this morning? *

Is your pet on any medications or supplements?

If yes, please specify which medications and when they were last given

Reason for drop off(complaint) *

Procedures to be performed *

Additional Elective Procedures:

Microchip ($35) *

Heartworm Test ($33.26) *

Fecal ($26) *

Clean Ears / Pluck Hair ($18) *

Anal Gland Expression ($18) *

Nail Trim ($15) *

Vaccinations *

Rabies
Da2pp
Lepto
Bordetella
FVRCP
FeLV

Please read the following and sign below:

I am the owner (or authorized agent of the owner) of the animal described above, and have the authority to execute this consent.The procedures listed above have been explained to my satisfaction and understand that while I expect all procedures to be done to the best of the abilities of the professional staff, I realize that no guarantee or warranty can ethically or professionally be made regarding the results or cure. I authorize the procedures listed above to be performed and will be contacted by phone about any additional procedures. I understand that hospital personnel will be employed in treating my pet. I have carefully read, and fully understand, this consent. The fees associated with these services have been explained to me, and I agree to pay such fees at the time my pet is released from the hospital. *

I have read and understand.

Date *

Phone Number *

Witness *

Signature *

Clear Signature

Comment

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We proudly serve the pets of Omaha, Florence, Fort Calhoun, Crescent IA, Ponca Hills, Raven Oaks, Benson, Omaha Country Club, Lake Cunningham, and beyond. Use the button below to request an appointment with us.

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Contact Information

Phone: 402-451-7001
Email: info@florenceanimalhospital.net

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Hours

Mon – Fri: 8 AM to 5:30 PM
Sat: 8 AM to 12 PM

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Address

8305 N 30th St.
Omaha, NE 68112

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